The American Academy of Pediatrics (AAP) and Trust for America's Health (TFAH) issued a new report today, Pandemic Influenza: Warning, Children At-Risk, which finds that children and teens between the ages of 0-19 account for nearly 46 percent of all H5N1 “bird” flu cases and deaths. The report also identifies gaps in U.S. preparedness for treating and caring for children during a possible pandemic flu outbreak.

Four key areas of concern raised in the report include: child-appropriate doses of vaccine and medications; management and treatment of children who become ill; including children in strategies to slow the spread of influenza in communities; and caring for and supervising the health of children if schools and childcare facilities are closed for extended periods of time.

“Children are not simply small adults, especially when it comes to medical concerns. The fact that H5N1 has been disproportionately impacting children and adolescents should give us pause,” said Jeff Levi, PhD, Executive Director of TFAH. “As the U.S. prepares for the threat of a possible pandemic flu, we must make caring for our kids a priority, not an afterthought.”

Some key gaps identified in the report include:

There are currently only 100,000 courses of antivirals for children in the Strategic National Stockpile. There are currently 73.6 million children in the U.S. A severe pandemic outbreak could result in 25 percent of the U.S. population becoming ill. Children are known to often be disproportionately impacted by contagious respiratory illnesses.

Neither of the two antiviral drugs that have been shown effective against H5N1 are licensed for children younger than 1 year of age.

A vaccine that is well-matched for a pandemic would not be available for at least 6 months after a major outbreak begins, and tests would have to be conducted to determine safety levels for children and adults once it is available.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that the public consider using of N95 respirator masks in certain circumstances during a pandemic outbreak, however, N95 respirator masks are not currently produced in children's sizes.

Approximately 30 million children rely on the National School Lunch Program for meals each day and many rely school nurses for health care, and there are no plans in place to provide these services if schools are closed.

“Children tend to be major vectors. They are inherently more at-risk for contagious respiratory diseases because they have limited pre-existing immunity, often spend lots of time in groups, and tend to share germs easily,” said AAP Committee on Infectious Disease (COID) Member John S. Bradley, MD, FAAP, of Children's Hospital San Diego. “Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among those most at-risk.”

Experts predict a severe pandemic flu outbreak could result in up to 1.9 million deaths in the U.S., approximately 9.9 million Americans needing to be hospitalized, and an economic recession with losses over $680 billion to the U.S. Gross Domestic Product.

“What will happen when children miss school? How long can parents stay home to care for their children? These are the million dollar questions parents and policy-makers should think about now while we have time to prepare,” said Henry H. Bernstein, DO, FAAP, AAP COID Member and Chief, General Pediatrics, Children's Hospital at Dartmouth.

The AAP and TFAH recommend specific actions to ensure the health and welfare of the nation's children are protected in the event of a flu pandemic:

Pediatricians and pediatric medical and surgical subspecialists should be included in pandemic planning at all levels of government.

The U.S. Department of Health and Human Services (HHS) should conduct additional studies on vaccine efficacy in young children, support the development of additional flu vaccine products, and conduct more studies of antiviral agents for infants.

HHS should immediately convene an independent task force to study and make specific recommendations about the use of surgical masks, N95 respirators, and other personal protective equipment by children.

HHS should conduct further studies on the feasibility of prolonged school and childcare center closures, including a more precise assessment of the long-term interruption of the school meals program and how to mitigate the impact on students who rely on them.

The Federal government should ensure that the Strategic National Stockpile includes sufficient pediatric doses of antiviral medications to ensure treatment of 25 percent of the nation's children and adolescents, or about 18.4 million individuals.

All schools should educate students in infection control. Children should receive grade-appropriate health education about communicable diseases and methods to interrupt disease spread (cover cough, wash hands, etc).

Educators and school administrators should be encouraged to get an annual influenza vaccination and should remind families that public health experts recommend annual flu vaccines for 1) all children with high risk conditions who are 6 months of age and older, 2) all healthy children ages 6 months through 59 months, 3) all household contacts and out-of-home caregivers of children with high risk conditions and of children younger than 5 years if age, and 4) all health care professionals. CDC and state and local health departments should encourage and support seasonal flu vaccination clinics in school settings to maximize flu vaccine coverage rates.

About The Pew Charitable Trusts

The Pew Charitable Trusts is driven by the power of knowledge to solve today's most challenging problems. Pew applies a rigorous, analytical approach to improve public policy, inform the public and invigorate civic life.

Trust Magazine

Our quarterly news magazine. Every issue features articles on Pew’s work from across the organization.Read Current Issue